India’s COVID-19 outbreak has set new records with 2,023 deaths in 24 hours – the highest single-day tally for the country so far – as hospitals run perilously low on oxygen amid rising demand for beds.
Coronavirus infections also rose by a record, increasing by 295,041 over the last 24 hours, the health ministry data showed on Wednesday. Total deaths reached 182,553.
India’s overall case tally is now at 15.6 million, second only to the United States which has over 31 million infections.
But Indian hospitals are scrambling to shore up supplies of medical oxygen amid rising demand for beds as a fast-spreading second wave of coronavirus stretches the country’s chronically underfunded medical infrastructure to breaking point, officials and doctors said.
‘No place for you’
Seema Gandotra, sick with the coronavirus, gasped for breath in an ambulance for 10 hours, as it tried unsuccessfully at six hospitals in India’s sprawling capital, New Delhi, to find an open bed.
By the time she was admitted, it was too late, and the 51-year-old died hours later.
Rajiv Tiwari, whose oxygen levels began falling after he tested positive for the virus, has the opposite problem: He identified a hospital that could accommodate him but the 30-something resident of Lucknow in Uttar Pradesh state could not get to it.
“There is no ambulance to take me to hospital,” he said.
Indian hospitals are understaffed and overflowing. Intensive care units are full. Nearly all ventilators are in use and the dead are piling up at crematoriums and graveyards.
Patients suffering from COVID-19 get treatment at the Lok Nayak Jai Prakash Hospital in New Delhi [Danish Siddiqui/Reuters]“We are facing huge problems in oxygen supply but somehow we are managing. Yesterday, it was very critical. We had only four to five hours oxygen in the evening,” said Ronit Kumar, head Biomedical Engineering at Fortis Escorts Heart Institute.
Replenishment came before dawn on Wednesday, with enough to last through the day, he said, adding they were pushing their suppliers. “Since they are also facing huge requirements, so I don’t know. I have not got confirmation,” he said.
A source at Indraprastha Apollo Hospital in New Delhi, a top private hospital, said staff had a “crazy night” as they ran short of oxygen but two tankers finally arrived after midnight. The hospital has 12 to 14 hours of oxygen left for 200 patients relying on it, the source added.
“We were hand to mouth but hoping the supply levels will increase from today,” said the hospital source, who is not authorised to speak to media.
There were no beds either for COVID-19 patients in about 80 of 142 hospitals in Delhi, according to government data.
Kamla Devi, a 71-year-old diabetic, was rushed to a hospital in New Delhi when her blood sugar levels fell last week. On returning home, her levels plummeted again but this time, there were no beds. She died before she could be tested for the virus.
“If you have corona(virus) or if you don’t, it doesn’t matter. The hospitals have no place for you,” said Dharmendra Kumar, her son.
The government issued a call for help on social media, saying large government hospitals only had enough oxygen to last another eight to 24 hours while some private ones had enough for just four or five hours.
I urge central govt wid folded hands to urgently provide oxygen to Delhi https://t.co/ElqckwAWT0
— Arvind Kejriwal (@ArvindKejriwal) April 20, 2021
Delhi Chief Minister Arvind Kejriwal, who on Tuesday went into self-isolation after his wife tested positive, tweeted late on Tuesday that some hospitals in the capital “are left with just a few hours of oxygen”.
The city’s health minister, Satyendar Jain, urged the federal government to “restore oxygen supply chain to avert a major crisis”.
Hospitals in the western state of Maharashtra and its teeming capital Mumbai, the epicentre of the surge, were also experiencing dire shortages, press reports said.
“Normally we would shift some patients to other hospitals… none in the city have spare oxygen,” NDTV channel quoted one doctor in the state as saying.
Meanwhile, Shahid Malik, who works at a small supplier of oxygen in Delhi, said that the demand for medical oxygen had increased by a factor of 10. His phone has been ringing continuously for two days. By Monday, the shop still had oxygen but no cylinders.
He answered each call with the same message: “If you have your own cylinder, come pick up the oxygen. If you don’t, we can’t help you.”
COVID tests delayed
Coronavirus tests are also delayed, which may worsen the crisis as many sick people can’t get tested fast enough to isolate themselves.
Everyone was “caught with their pants down,” said A Velumani, the chairman and managing director of Thyrocare, one of India’s largest private testing labs. He said that the current demand was three times that of last year.
“We can’t cater to the demand,” said Dr Vidur Mahajan of Mahajan Imaging in the Indian capital, who has temporarily shut two of his three sample collection points due to a backlog of pre-booked tests, and to prioritise testing for government hospitals.
Officials from four diagnostics companies, including Mahajan, said samples currently being tested daily were between 300 percent-650 percent higher than February, putting infrastructure and personnel under severe pressure.
Doctors and patients in New Delhi and financial hub Mumbai said it was taking between three and eight days to find slots for the highly accurate RT-PCR tests and get their results.
If sample arrivals rise further, by 25 percent to 30 percent, “probably the testing facilities will crash, in terms of turn-around time at least,” said A Ganesan, group vice chairman of Neuberg Diagnostics, which runs 14 testing labs across India.
“We will have to turn back some of the patients without collecting their samples.”
With test results often delayed, doctors said they were relying on CT scans and symptoms to treat patients.
“What is happening because of the delayed testing is that the circle of transmission is getting wider and wider,” said Dr Ravindra Khade Patil of Sushrut Hospitals on the outskirts of Mumbai.
“Without a test, the patient may not isolate and thus infect others.”
Vaccination drive struggling
India launched a vaccination campaign in January but only a tiny fraction of its population has received shots and the enormous drive is struggling.
Notices about the shortage of COVID-19 vaccines seen outside a vaccination centre in Mumbai [Francis Mascarenhas/Reuters]India said last week that it would allow the use of all COVID-19 shots that had been approved by the World Health Organization or regulators in the US, Europe, Britain or Japan.
On Monday, it said that it would soon expand vaccinations to include every adult in the country, an estimated 900 million people.
But with vaccines in short global supply, it is not clear when Indian vaccine makers will have the capacity to meet these goals. Indian vaccine maker Bharat Biotech said it was scaling up to make 700 million doses each year.
‘Like a storm’
In a televised address to the country on Tuesday evening, Prime Minister Narendra Modi said India faced a coronavirus “storm” overwhelming its healthcare system.
“Oxygen demand has increased. We are working with speed and sensitivity to ensure oxygen to all those who need it. The centre, states and private companies, all are working together,” Modi said.
Modi faces criticism that his administration lowered its guard when coronavirus infections fell to a multi-month low in February and allowed religious festivals and political rallies, some of which he permitted to go ahead.
“The situation was manageable until a few weeks ago. The second wave of infections has come like a storm,” Modi said in his address, urging citizens to stay indoors and not panic amid India’s worst health emergency in memory.
New Delhi is under a six-day lockdown to try and stem the transmission. The western state of Maharashtra, home to the financial capital Mumbai, also plans to impose a stringent lockdown this week to try to halt the rise in cases, the cabinet said.
Modi ordered a tough lockdown of India’s 1.3 billion people when the coronavirus was detected last year but his government has always been wary of the huge economic costs of tough restrictions.
He said on Tuesday a lockdown should only be a “last resort”.
‘India failed to learn’
Bhramar Mukherjee, a biostatistician at the University of Michigan who has been tracking India’s pandemic, said India failed to learn from surges elsewhere and take anticipatory measures.
When new infections started dipping in September, authorities thought the worst of the pandemic was over.
Health Minister Harsh Vardhan even declared in March that the country had entered the “endgame”, but he was already behind the curve: average weekly cases in Maharashtra state, home to the financial capital of Mumbai, had tripled in the previous month.
Mukherjee was among those who had urged authorities to take advantage of low cases earlier in the year to speed up vaccinations.
Instead, officials dithered in limiting huge gatherings during Hindu festivals and refused to delay ongoing elections in the eastern West Bengal state, where experts fear that large, unmasked crowds at rallies will fuel the spread of the virus.
Now India’s two largest cities have imposed strict lockdowns, the pain of which will fall inordinately on the poor.
Many have already left big cities, fearing a repeat of last year, when an abrupt lockdown forced many migrant workers to walk to their home villages or risk starvation.
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